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Parent's Name
Student's Name

Payment by Bank Draft

If you choose Bank Draft, please enter your financial institution account information into the fields provided below:

Electronic Funds Transfer Authorization Form (EFT) - Bank Draft - (Preferred Method)

As a duly authorized check signer on the financial institution listed below, I authorize Dana’s Studio of Dance- Southlake, Keller or Coppell to perform scheduled or periodic electronic funds transfer debits and/or credits from my account identified below for payments due or when applicable, apply electronic funds credits to the same. This applies to check by phone payments as well as any other electronic payments.

I understand the dollar amount can vary depending on the services performed. Monthly tuition payments will be transferred on the 1st of every month. Costume fees and recital fees will be processed on the 15th of the month in which they are due. Additional payments (ie private lesson fees etc.) will be transferred at the time the expenses are incurred (you will be notified prior to any such billings).
Furthermore, if any such electronic debit(s) should be returned by my financial institution for any reason, including non- sufficient funds (NSF), I authorize DSOD to collect a returned item fee of $30.00 per item by electronic debit from my account identified below.

For accounting purposes, all electronic debits will be reflected in the monthly bank statement that corresponds with the account identified below.

I understand and authorize all of the above as evidenced by my submission below.

I agree that I have registered online and authorize Dana's Studio of Dance Southlake, Keller, or Coppell to use this information for payment.

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